Provider Demographics
NPI:1770545436
Name:GEORGE, EARL F (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:F
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3821
Mailing Address - Country:US
Mailing Address - Phone:316-687-9794
Mailing Address - Fax:
Practice Address - Street 1:2535 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:316-687-9794
Practice Address - Fax:316-689-6957
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS052263Medicare ID - Type Unspecified
KSB60545Medicare UPIN